Kleptomania: Clinical Characteristics and Treatment - Research Paper Example

Running Head: KLEPTOMANIA Kleptomania: A Short Review of the Under the guidance of APA format Introduction Kleptomania or compulsive shoplifting is an impulse control disorder that is distressing and disabling in nature. It is mainly characterized by uncontrollable, repetitive and useless theft of items that can result in significant distress and can initiate a sequence of legal and moral consequences (Grant and Odlaug, 2008). Due to lack of appropriate epidemiological studies, the condition is poorly understood, and the incidence and prevalence of this condition in general population is unknown. However, a few studies amongst psychiatric patients have revealed that kleptomania is a fairly common condition (Grant and Odlaug, 2008). There is recent surge in the research pertaining to kleptomania that has led to some understanding of the clinical presentation, pathophysiology and management of the condition; the details of which will be elaborated in this essay. Clinical presentation Kleptomaniacs do not usually consult physicians on their own. They are either brought to the medical attention either by their parents and well-wishers, employers, teachers or school counselors. Despite distress because of stealing, majority of kleptomanias do not report about their shoplifting habit to their physicians (Grant and Kim, 2002). One of the reasons could be fear of exposure of theft and subsequent legal consequences. Reluctance to expose their habit, shame on activities of oneself and lack of clinicians familiarity with the condition prevent kleptomania from being recognized and diagnosed (Grant and Kim, 2002). According to the Diagnostic Statistical Manual- IV-TR (Grant and Odlaug, 2008), diagnosis of kleptomania is established when a person exhibits “1) recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value, 2) increasing sense of tension immediately before committing the theft, 3) pleasure, gratification, or relief at the time of committing the theft, 4) the stealing is not committed to express anger or vengeance and is not in response to a delusion or a hallucination and 5) the stealing is not better accounted for by conduct disorder, a manic episode, or antisocial personality disorder" (Grant and Odlaug, 2008). Kleptomaniacs frequently steal items that are unnecessary for them. Infact, many stolen items are either given away to others or stolen or even returned. Kleptomaniacs are frequently referred to as bad people without realizing that it is the illness that is causing the urge for them to steal. It is however, difficult to draw a distinction between maladaptive behavior and compulsive behavior. The DSM-IV classifies kleptomania under impulse-control disorders. While making a diagnosis of kleptomania, other conditions like conduct disorder, attention deficit hyperactivity disorder and eating disorder must be ruled out (Grant and Kim, 2002). Kleptomania can be comorbid with many conditions like paraphilias, other impulse control disorders, substance and alcohol abuse, personality disorders and mood disorders. Amongst personality disorders, borderline, paranoid and schizoid personality disorders are more likely to be associated with kleptomania (Grant and Odlaug, 2008). Kleptomania can result in significant impairment of cognitive functioning and social life. Persons with this condition have problems in employment and occupation. The urge to shoplift disturbs kleptomanics so much that they often find it difficult to concentrate at work, school and also at home. Education is often compromised, employment gets disturbed and thus poor quality of life ensues. They also develop dissatisfaction in life (Grant and Kim, 2005; cited in Grant and Odlaug, 2008). Other than emotional consequences, kleptomaniacs, especially male kleptomanics, get entangled in legal consequences. (Grant and Kim, 2002; cited in Grant and Odlaug, 2008) reported that the mean number of apprehensions faced by a kleptomaniac is 3. About 15-23% of kleptomaniacs get jailed for shoplifting (Grant and Kim, 2002; cited in Grant and Odlaug, 2008). Epidemiology There are very few studies which have researched the epidemiology of kleptomania. Infact, the incidence and prevalence of the condition is not yet established. Racial and ethnic preferences are not yet evaluated. Kleptomania is often referred to as secret psychiatric disorder (Grant and Kim, 2002). Despite evidence of onset of kleptomania in adolescence, there is no mention of this condition in adolescent psychiatric literature (Grant and Kim, 2002). Some reports show that two-thirds of kleptomaniacs are women (Grant and Kim, 2002). However, there are no proper epidemiological studies pertaining to sex domination. Although, many experts are of the opinion that female kleptomanics are brought under medical attention and male patients are sent to jail and hence it appears that females have more prevalence of kleptomania (Grant and Odlaug, 2008). Pathophysiology The pathophysiology of kleptomania is not fully understood. Although there are reports that kleptomania can run in families and is associated with substance abuse in first degree relatives, there are no proper studies to support this eveidence. Other conditions which are noted in kleptomaniac patients first degree relatives are mood disorders, alcohol abuse and kleptomania itself (Grant and Odlaug, 2008). Thus a role of genetic factors is seen in the pathophysiology of kleptomania. Experts are in search for the cause of the uncontrollable behaviour in kleptomaniacs. Some hypothesise the role of serotonergic dysfunction in the ventromedial aspects of prefontal cortex in the causation of urge behaviour in kleptomaniacs. Others have incriminated frontal lobe dysfunction as a causative factor. there are some reports that executive functioning and cognitive functioning are deranged in kleptomaniacs. Neuroimaging studies have reported damage to orbito-subcortical circuits in the brain (Grant and Odlaug, 2008). Treatment There is not much published data on the treatment of kleptomania. Whatever studies are available so far are on a small number of patients. As of now, there are no pharmacological agents approved by the Food and Drug Administration to treat kleptomania (Grant and Odlaug, 2008). Certain case reports have established the role of certain medications in the treatment of the disorder. Fluvoxamine, paroxetine, escitalopram, combination of fluoxetine and imipramine, combination of sertraline and methylphenidate and valproic acid are some of the drug regimens which have been found useful in the treatment of kleptomania (Grant and Odlaug, 2008). These drugs are basically antidepressants. All anti-depressants act via monoamine neurotransmitters serotonin or noradrenaline. They down-regulate (decrease or desensitize) some receptors in a delayed time course, which is reflected by the time to onset of therapeutic effects. Antidepressant drugs actually induce plastic changes in neuronal connectivity, which gradually lead to improvements in neuronal information processing and recovery of mood (Castren, 2005). Imipramine is a tricyclic antidepressant. Tricyclic antidepressants act by inhibition of mixed noradrenaline and serotonin reuptake. Fluoxetine and escitalopram are elective serotonin reuptake inhibitors which act by inhibition of serotonin-selective reuptake. Paroxetine is a noradrenaline reuptake inhibitor that acts by inhibition of noradrenaline-selective reuptake. The success of many of these treatments has been questioned by many experts in through their case studies. Other drugs which have been determined to be useful are topiramate, citalopram, lithim and naltrexone. Two small open label studies have demonstrated the usefulness of escitalopram and naltrexone in subsidence of urge behaviour in kleptomania. The effective dose of naltrexone has been established to be 145mg per day. the course of treatment is for a minimum of 12 weeks (Grant and Odlaug, 2008). Naltrexone has been used to treat kleptomania because it decreases "urge" to steal. thus this drug has been useful in treating alcoholism, cocaine buse, pathological gambling and other such urge related conditions (Grant and Kim, 2002). Other than pharmacological treatment, reports have shown that psychotherapies also may benefit patients with kleptomania. Cognitive Behavioral Therapy or CBT is a form of psychotherapy that mainly influences dysfunctional and problematic cognitions, emotions and behaviors through a goal- oriented systematic approach. The main objective of the treatment is to identify thoughts, beliefs, assumptions and behaviors that are related to debilitating, dysfunctional, inaccurate and unhelpful negative emotions and monitor them. The result expected out of such forms of therapy is to replace or transcend these emotions with more realistic and useful emotions. It is important to know that emotional dysfunction is maintained by metacognitive beliefs, inflexible self-focused attention, and perseverative thinking. CBT should be delivered only by those who are trained suitably. The therapists should adhere to empirically grounded treatment protocols. CBT is a symptom oriented therapy approach combining psychoeducation and specific treatment intervention. The most important advantage of CBT is that it is brief and time oriented (Cooper, 2008). Many techniques of CBT are adapted for self- help applications. CBT is a highly structured therapy. Hence it can be provided in a number of different formats such as computer interface, self- help books and training material. Forms of CBT which are useful are systematic desensitisation, covert sensitisation and aversion therapy (Grant and Odlaug, 2008). However, there are no controlled studies to establish the usefulness of psychotherapies for evidence-based practice. Conclusion Kleptomania is a chronic mental illness that presents as compulsive shoplifting behavior with disturbing social, legal, functional and legal consequences. This condition though common, is under-recognized, under-reported and under-studied. Though there are many treatment forms which have been proposed for management of kleptomania, there are proper coherent studies to recommend appropriate treatment regimens. Thus there is a dire need for further evaluation and research in this field, expecially in dosing regimens of pharmacotherapy and duration of treatment. References Castren, H. (2005). Is mood chemistry? Natural Reviews Neuroscience, 6(3), 241-6. Cooper, M. (2008). Essential Research Findings in Counselling and Psychotherapy: The Facts are Friendly. London: SAGE Publications. Grant, J.E., and Odlaug, B.L. (2008). Kleptomania:clinical characteristics and treatment. Rev Bras Psiquiatr, 30(supl), S11-15 Grant, J.E., and Kim, S.W. (2002). Adolescent kleptomania treated with naltrexone. European Child and Adolescent Psychiatry, 11, 92-95. Read More